Abstract
BackgroundOsteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America.MethodsWe conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico.ResultsThe Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40–94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were − 3.02 (1.23) at the lumbar spine and − 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline.ConclusionsThis baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.
Highlights
Osteoporosis is a major healthcare concern in Latin America
Cunha-Borges et al Advances in Rheumatology (2019) 59:46 (Continued from previous page). This baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures
Use of teriparatide in the general population may be restricted to those who have private insurance policies, which cover teriparatide treatment. This LA subregional analysis of the ALAFOS study provides useful insights into the patient population that is currently being prescribed teriparatide in the four participant countries in a realworld setting. In this subregional analysis of the ALAFOS baseline data, we found that patients who are prescribed teriparatide in LA are usually elderly women with severe osteoporosis who are at a high risk of fracture
Summary
Osteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. Osteoporosis is a systemic bone disease characterized by loss of bone mass and deterioration of bone microarchitecture and bone quality, leading to an increased risk of fragility fractures [1]. Osteoporotic hip and vertebral fractures have a significant adverse impact on the quality of life [3]. There is increasing awareness about the importance of osteoporotic fractures at sites other than the hip and spine, which contribute substantially to disability and impaired quality of life [4]. The direct and indirect annual costs of hip fracture were estimated to be USD 34.8 billion worldwide in the year 1990; worldwide costs of osteoporosis are expected to reach approximately USD 132 billion by the year 2050 [1, 3]
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